Monday, June 30, 2008

Those folks who pay attention to these things may have noticed that we've been in the Top 20 at Wikio (Health) for quite some time, most recently at #16. I just received confirmation from the Wikio folks that that's about to change:

"I am contacting you about the new Wikio ranking for July. Your blog InsureBlog moved from 16 to 11 this month."

While I'm still relatively clueless about how those rankings are determined, it stands to reason that readership plays at least some part, and so I'd like to thank our loyal (and brilliant, of course) readers.

UPDATE: I've just received a follow-up email confirming that we're #10.

Little Hailey (and her baby brother) suffers from Late Infantile Batten Disease, which causes loss of muscle co-ordination and seizures that do not respond to anticonvulsant drugs. It is (apparently) always fatal. Other than this new, experimental treatment, there is no cure; a patient's life expectancy is about age 12.

Once Hailey (and her mother) had reached Vancouver, Air Canada insisted on making their own determination as to whether or not she was fit to fly. Unfortunately, during the wait for the Air China flight, Hailey's health went from bad to worse, and she was admitted to Vancouver's Children's Hospital. When it was apparent that her health hadn't improved enough to make the flight to China, she was flown home, by air ambulance, to Kentucky.

It now appears that she will be unable to take advantage of the stem-cell treatment that may have extended her life expectancy.

This is just sad, on so many levels.

As a parent, I can certainly respect and empathize with her folks' desire to exhaust every single avenue, no matter the cost or the effort. But I can also see the airlines' perspective: if her health had deteriorated that fast just waiting for the next flight, how well would things have gone once they were in the air and over the Pacific*? And what liability would the airline face in the event that she suffered even more? And finally, what about the safety of the other passengers?

There's also the question of "what now?" Hailey's family is exploring the possibility of a direct commercial flight to China, or even ponying up the $125,000 cost of an air ambulance there. Since this is an experimental treatment, it's unlikely any insurance carrier would agree to foot that bill.

The association between birth season and health, meanwhile, has been confirmed repeatedly by studies published in peer-reviewed journals.

It was first noticed with the neurological disorder schizophrenia; subsequent research has shown the month of birth can influence your risk of suicide and chance of developing certain cancers, Crohn's disease, coronary heart disease and brain tumors, says psychiatrist Emad Salib of Peasley Cross Hospital in Britain,

That's a fairly broad association if you ask me.

Literature reviews, meanwhile, show that more patients with schizophrenia, Alzheimer's disease, epilepsy and narcolepsy are born in December and January. Those with affective disorders—alcohol dependence, autism, dyslexia and multiple sclerosis—are reported more frequently in those born during spring and summer months.

And what is the correlation?

A mother's health is the root of several possible explanations. For instance, the fetal origins hypothesis holds that early environmental conditions in utero and during infancy can program human immune development. Some of these factors include a mother's access to fresh vegetables or vitamins, or her exposure to an infectious disease such as influenza that might harm the brain of a developing fetus.

OK, I might be willing to buy into that.

So is there any good news?

"Children born in autumn will tend to be the biggest, strongest and most developed in their school year," he said. "So they are more likely to do better in sport, which may motivate them to stay active.

But then there is this . . .

Of course there will always be October-born people who are sedentary and June babies with perfect vision. Season of birth research is in its infancy, so it shouldn't weigh into family-planning decisions.

As a September baby, I am more inclined to think I am in the bigger, stronger category.

Would she have been satisfied with the increase if her health was poor?

as far as Blue Shield is concerned, Hack and all other women are somehow more accident-prone, or more likely to break a bone, or more susceptible to costly ailments.

Why? Because they're women.

Says who?

"Our egghead actuaries crunched the numbers based on all the data we have about healthcare,"

Egghead actuaries.

Is that their official title?

And then there is this.

Individual health insurance typically costs more than group coverage because the risks can't be spread among a large number of people. Such risk pools allow all people with group policies to be insured equally, without biases for age or gender.

That's not a quote from Blue or any other carrier. So what idiot reporter inserted that bit of information?

Idiot reporter.

That is their official title.

But parsing rates according to gender is a relatively new phenomenon

Another non-quote from our idiot reporter.

Back to the pricing differential . . .

By age 20, women are paying $119 monthly, while men are charged $110.

Sounds like men need to complain they are being under-charged and that isn't fair.

Friday, June 27, 2008

Over the years, we've touted the benefits of chocolate-based health care: whether you're pregnant, overweight, or just suffering from high blood pressure, chocolate seems to be the "go to" dietary hero (well, maybe next to tomatoes). It's not enough, apparently, for scientists merely to acknowledge cocoa's seminal role in the health care arena; now they want to map the delicious pod's genome:

It seems that there are a host of challenges that affect cocoa crops, from fungi to droughts, and researchers believe that they can learn more (and better) techniques for protecting the world cocoa bean supply by more completely understanding what makes it "tick."

It's actually a pretty interesting venture, with leading edge genetic research which promises to have positive, real-world impact.

And poor Mrs de Vires? Well, she's from Ontario, and because the Canadian system wouldn't approve treatment for her, she took a little trip down to Michigan. There, a surgeon successfully removed her tumor, and none too soon: the surgeon estimated that "she could not have lived longer than a few weeks more."

And you may be wondering about the folks being "stored" in ambulances. In Britain, it has become commonplace for acute care patients to have long waits before being seen, much less treated. So the Ministry of Health promulgated a new rule requiring that those in need of emergency care receive it inside four hours. All well and good in theory, but the Law of Unintended Consequences trumps a mere gummint regulation, and so hospitals refused to allow the patients inside; that four hour meter didn't start ticking until they hit the actual door.

I'll give "the father of Quebec medicare" the last word on this:

"We are proposing to give a greater role to the private sector so that people can exercise freedom of choice."

At the time, UHC was in the midst of negotiations with super-sized health care provider OhioHealth. Since doc's like nothing more than to field calls from irate patients, the thinking must have been along the lines of "hey, let's rile up our customer-base, and point them at their own doctors and hospitals." It was probably considered to be a no-lose situation: "hey, we're just the poor ol' insurance company, looking to save our policyholders a few bucks. What y'all do with this information is strictly up to you."

Unfortunately (for UHC, at least), it didn't work out quite that way:

"The investigation was sparked by those complaints and media attention, as well as the fact that UnitedHealthcare is one of the health plans offered to state employees."

Gotta love that last: given that at least a few of their policyholders would almost have to be DOI employees, one would have thought that UHC might have been more, um, circumspect about the whole thing.

The issue will boil down to whether or not any laws or regulations were broken by this perhaps ill-advised venture; it calls to mind the Anthem vs Premier kerfluffle a couple of summers back. Regardless, "investigating" doesn't mean "found guilty." It may well be (and I suspect that it will be) that nothing will come of this.

Consumer-centric health care begins with (what else?) the consumer. On an obvious level, this means choosing the right health insurance plan, knowing its benefits and limitations, and being aware of how it works best. It also means keeping the line of communication between yourself and your providers (doctors, pharmacists, specialists, etc) open, and not being afraid to ask a lot of questions.

But sometimes, the world of health care can be a frustrating set of numbers, codes and phone numbers (and even, sometimes, actual human beings). Wouldn't it be nice to have someone on your side who knows how to navigate the maze that is health care?

That's the premise behind Assurant's new initiative: Patient Care. Well, actually, it's not Assurant's initiative per se: they're making available a "new" service called Patient Care. The company itself was started in 2001, and bills itself as "an independent advocacy company whose sole purpose is to resolve a healthcare problem or assist a member with health insurance and benefit issues." One can avail oneself of PC's services for the (ahem) "modest" fee of $1,000 (or up to $3,000 for a family).

Or, one could simply purchase a new Assurant major med plan, and it's a freebie. Not a bad deal.

This is the latest in what appears to be a wave of new "value added" services that carriers are pushing to help differentiate themselves (and their products) in an increasingly homogenous-looking market. We saw it recently in Companion Life's new "medical tourism" benefit, and I'm sure we'll see it in other forms, from other carriers, in the near future.

While I still maintain that choosing the right product design in the first place is more important than these little "gimmies," they do help with brand identification and, perhaps, as an added incentive to purchase.

HWR is one one my favorite "carnivals:" it appeals to my "inner geek," and I almost always discover a new (to me) health blog. This week's 'Review is particularly well done: host Jaan Sidorov adds his own "take" on most of the entries, which spices things up even more.

Some 10 years ago, when HIPAA was a newborn, my CE partner and I did the unthinkable: we actually read the whole thing (200+ pages), and developed what became our most popular class. Ray found a little nugget called the "National Provider Number" (NPI). Sounds innocuous enough, but as Dr Zagreus Ammon explains, there's a lot more than meets the eye.

Wednesday, June 25, 2008

Don't know how I missed this, but tax-blogger extraordinaire Joe Kristan has a compelling post about the tax implications of a business insurance claim. Joe explains, in easy to follow terms, why a "no brainer" may have some drastic consequences.

Back in the day, now-ubiquitous TV pitch man Billy Mays introduced us to the wonders of OxyClean. I must admit, it's one of my favorite products: it's reasonably priced, and it really works. The question is, does that kind of success transfer to less tangible products, such as health insurance?

Recently, the bearded wonder became the official spokeman for something called "iCan Benefit," a website that purports to offer great deals on health insurance. They actually offer two "flavors:" a guaranteed issue, limited benefit (mini-med) plan and a "regular" (i.e. underwritten) major medical plan.

Neither is particularly special; the mini-med plan seems to have pretty much all the features of any of its ilk, and is priced accordingly. That is, it's competitive but not particularly so.

The major med plan is underwritten by Assurant, which is a very decent carrier, with good service and decent products. I haven't been especially impressed with their underwriting or pricing (although they do at least try to offer less generic products). Keep in mind, though, that this is not a group plan, which means that full underwriting applies.

What does that mean, exactly?

Simply this: you'll still need to complete a full application, disclosing your medical history, current problems and any med's you're on (or have been on recently). And Assurant can exclude conditions or med's, or even turn you down altogether. Of course, that's typical of the individual major med market, but it's important to remember that joining iCan doesn't buy you an underwriting (or pricing) break.

It does mean that you'll pay an extra association fee, though.

iCan suggests that "You can think of us like a close friend who knows all about health insurance." Not a bad pitch: after all, we often suggest that you ask friends, neighbors, and the like for a referral to a good agent. But that doesn't mean that these folks are ipso facto experts on insurance; merely that they've had good experience with a particular agent or carrier.

Bottom line: seek out a professional, independent agent with at least 5 years of relevant experience, and who represents more than just the one company.

Tuesday, June 24, 2008

Red Green touts duct tape as "The Handyman's Secret Weapon." Little does he know that the brilliant scientists of the Centers for Disease Control in Atlanta have their own take on the ubiquitous adhesive:

The brainiacs at the Center's Emerging Infectious Diseases Laboratory, which cost over $200 million dollars (or in gummint-speak, "chump change"), have been using roll after roll of the silver stuff trying to prevent the escape of the potentially fatal "airborne Q fever."

In their defense, the scientists claim that the duct tape is merely an "enhancement;" insurance (if you will) added to bolster the containment systems already in place. Of course, we've all heard thatbefore.

That's right, Barbara Wagner's been offered an admittedly effective (if draconian) treatment alternative: death. Granted, this would end her suffering and save untold thousands of taxpayer-provided dollars. But does anyone else think that this might be, um, drastic?

The good news, such as it is, is that nasty ol' Big Pharma has stepped up to the plate:

"(A) drug manufacturer that it will provide the expensive medication, estimated to cost $4,000 a month, for the first year and then allow her to apply for further treatment."

And yet we're constantly told that private sector-based health care is bad, while gummint-provided care is good. Maybe in Bizarro World, but apparently not in The Beaver State.

To add insult to (grevious) injury, Dr. John Sattenspiel (senior medical director of the company that runs Oregon's health plan) averred that there was "no intent to upset her, but we do need to point out the options available to her under the Oregon Health Plan."

Monday, June 23, 2008

Over 25 years ago, my first job in the insurance biz was as an agent with one of the few remaining "debit" companies.

[ed: many years ago, a lot of companies sold (relatively small) policies with premiums collected weekly. Agents were assigned a territory, or "debit," from which to collect and, hopefully, make new sales. I'm not aware of any carriers which still do this, although one might argue that payroll deduction, or "worksite marketing," plans are the natural evolution of this market]

My debit included a relatively affluent area, and a high-rise apartment building wherein lived a number of retirees. One evening, as I sat in the apartment of one such couple, they asked me if I enjoyed stand-up comedy. I replied that I did, and they told me that their daughter was married to a stand-up comedian, and perhaps I'd heard of him. At the time, HBO had a series of "specials" highlighting new talent, and I thought that maybe they'd mention one that I'd seen. So I innocently asked "which one?" The lady of the house replied almost apologetically (perhaps thinking that I'd never heard of her son-in-law), "well, our daughter is married to a comic named George Carlin. Have you ever heard of him?"

Of course, my jaw nearly broke as it hit the floor. Had I ever heard of George Carlin?! I'd basically grown up (so to speak) on his humor. I had had no idea that there was a hometown connection, let alone that I'd be sitting in his in-laws' living room. Mrs Hosbrook asked if I'd like one of his albums (they had "a few" laying around), and I said "oh, sure!" It turned out to be an autographed copy of (if I recall correctly) "Class Clown." What a treasure!

I left that carrier some 24 years ago, and lost touch with the delightful couple. But I never parted with the album (although I currently have no turntable on which to play it), and always felt a connection (feeble though it may have been) with the comic legend.

Saturday, June 21, 2008

According to the NAABC, the Internal Revenue Service recently issued two positive items on HSAs:

First, many people aren't aware that you can fund your HSA (Health Savings Account) with money you have socked away in an IRA (regular and/or decaf, er, Roth). This is a one time deal, not something you can do on a regular basis. According to the Service, if you decide to make the transfer, it won't be subject to the normal 10% penalty s a "distribution." This method is typically used to "seed" the account at start-up.

Good deal.

And it gets better:

The Health Opportunity Patient Empowerment Act of 2006 clarified (among other things) how one calculates one's maximum HSA contribution in a given year. Basically, it affirms that the amount you can contribute isn't necessarily limited to your deductible. Even if your plan's deductible is less than the max, you can contribute the maximum.

Sweet.

And finally, for those who actually received their "Stimulus" checks (and you know who you are), even more good news:

If your check was deposited directly into your HSA, you can safely withdraw it. This would apply to folks who had their regular tax rebates deposited directly to their HSAs.

As always, check with your own tax advisor to see whether (and how) this would affect you.

"Ed Yong, health information manager at Cancer Research UK, said: "It's very exciting to see a cancer patient being successfully treated using immune cells cloned from his own body."

The bad news is that, at this early stage, the treatment is quite expensive, and is likely to remain so for a while. This makes sense: new tech R&D is generally expensive. As it becomes more widespread and economies of scale come into play, costs tend to decline.

The major difference between this technique and earlier regemins is that it shows that "simply growing vast numbers of the few immune cells in the body to attack a cancer can be safe and effective."

Thursday, June 19, 2008

An odd thing happened a few days ago. A new client asked if they could pay more than the quoted premium.

"Well, sure . . . but why would you want to?"

First a little background information.

My client is actually a parent looking for coverage for his son. Currently his son has half a policy and is paying an outrageous amount.

The policy only covers hospitalization, no outpatient coverage at all. While many believe the hospital bill will kill your finances, it is what happens outside the hospital, and after you are discharged that usually is an amount equal to what you paid the hospital.

The dad asked for a high deductible, "bare bones" kind of plan. I ran the numbers and suggested a plan for $48 per month.

A very simple plan, true "bare bones" that is more than adequate for the large claim. In network claims up to $5,000 are discounted up to 70% and apply toward the deductible. Claims over the deductible are also discounted but paid in full by the carrier.

The most the insured will pay in any one year is $5,000.

All this for less than $600 per year.

That's pretty amazing if you ask me.

I sent the proposal over for review and added my comments and suggestions. A few days later his dad asked if he could pay more and get a lower deductible.

Dad figured if the big claim were to hit he would be the bank for the amount up to the deductible.

"Well, yes, you can pay more but you don't really get more."

This always throws people off. They think if you pay more you get more.

With most items this is true.

For $6 you get a salad. For another $8 you get an appetizer. Add another $20 and you get an entree.

Not so with health insurance.

For $62 (instead of $48) he can get the same plan as originally quoted but with a $3,000 deductible.

That is the point of diminishing returns. Anything over that is throwing your money away.

He can buy a plan with a $2500 deductible and $35 office copays for $101. But when a big claim hit's his OOP (out of pocket) is $4500 plus copays.

He can also buy a plan with a $1000 deductible and copays for $166 and his OOP on a big claim is $3000 + copays.

Or he can buy a $0 deductible plan for $236 and limit his out of pocket on a major claim to $500 + copays.

So in reality the $62 plan is the best buy.

But consumers don't want to believe that, so they end up paying more than is necessary and then complain about the high cost of health insurance.

At my suggestion he bought the $62 plan and pocketed the $100 in extra premium he would have paid if he had never contacted me.

To my way of thinking, an extra $100 per month will almost cover the increased cost of gas and groceries.

On the one hand, it's claimed that "(t)he vaccine, Gardasil, is proven to prevent infection from four particularly dangerous strains of HPV in women." That would seem to be a "slam dunk" insofar as vaccine's effectiveness is concerned.

Wednesday, June 18, 2008

Time once again for a brief walk on the P&C side of the insurance biz. As one who's shuttled kids back and forth to various afterschool activities, dances, practices and the like, I'm always mindful of the potential for a mishap. Thank goodness (and my personal liability unbrella) it's never been a problem for me, but that doesn't mean it can't be:

Turns out, Susanne Sadler (a New Jersey resident) offered to chaperone a cheerleaders' trip to Hawaii, where they were to perform in the Hula Bowl. Prior to that exciting opportunity, though, one of the students apparently decided it'd be a good idea to have a drink or two. She subsequently fell off a balcony and died. Ms Sadler isn't accused of giving or getting her the drink; nonetheless, she was sued and found to be at least partially responsible for the tragedy.

And now must cough up almost $700,000.

Which raises a number of questions:

Would your homeowner's liability policy cover you? What if it's over a few hundred thousand dollars?

Do you have an umbrella policy? Would it cover this kind of thing?

It's something I would never have thought to ask my co-worker (who's also my P&C agent). Until now. (For the record, he said "coverage? I've never seen you before in my life." So I've got that going for me) Seriously, ask your agent. Do it soon.

Something else to consider is whether or not the organization which sponsors such a trip has a liability policy. And it's not just an expense issue, either. According to the president of a school booster club:

"If we decided not to have any insurance, at some point a year or two from now, some parents might say they can't take the risks."

IB regulars are familiar with our anthem: Health insurance costs increase primarily because health care costs increase. To hear the Chairman of the Federal Reserve esentially endorse that position is indeed wonderful, but we won't let it get to our heads.

That increase is driven primarily by heavy and growing demand, and the rather counter-intuitive notion that increasing tech doesn't drive down the cost of health care.

[ed: To understand why that's counterintuitive, consider PC's. As they've gotten more powerful, with more features, they've actually gonedown in price. Not so with health care]

And that increase shows no sign of slowing down. According to Dr Ben, "(t)o buffer the effects of rising health-care costs on household budgets, the government may have to absorb an increasingly large share of the bill for those costs." Hunh? The government may have to absorb these costs? Um, no: we will absorb them: the gummint has no money. It must confiscate...er, uh, tax us to aquire it.

And gummint spending in the health care sector is a major driver of these increasing costs: "Medicare for retirees and Medicaid for low-income people — takes up 23% of federal spending that is not for interest payments." Ouch!

David Khorram hosts this week's Grand Rounds from the South Pacific at Marianas Eye. Its calming illustrations belie the frenzy of interesting posts.

As the grandson of (legal) immigrants, I've occasionally wondered whether any of them came through Ellis Island. Annie, at Home of the Brave, has discovered that the medical records of everyone treated at the Island's hospital have gone missing. I do love a mystery.

At first glance, this seems harmless enough: swapping one pill-form for another, assuming the formulations were equivalent. But it doesn't take a rocket surgeon to see that the whole point of the swap was to generate megabucks for the provider, at the expense of the taxpayer (i.e. you and me). And how much, exactly, did this little switcheroo cost us?

How about over a million dollars, in one year, just in Florida.

That's a lot of little pills...er, capsules. And it wasn't just for Zantac, either (although this story sure is giving me a heartburn): "generic Prozac (fluoxetine) for depression, and generic Eldepryl (selegiline) for Parkinson's," all were part of this little money-maker.

Of course, Walgreen's denies they did anything untoward (and they're apparently not the only big pharmacy chain with their hand in the cookie jar:

"CVS and Omnicare quietly settled similar cases coughing up $86 million more."

Sunday, June 15, 2008

For many of us it is a day to do what we want, eat what we want and be showered with another tie that will cause us to feign appreciation.

Father's are guy's and guy's are simple creatures. Dad's of a certain generation are mostly stoic, not easily given to emotion.

I grew up as part of the leading edge of the baby boomer generation. Life was simple then. Dad's went to work while mom stayed home. My mom cooked, cleaned the house (occasionally) but never in heels and pearls like June Cleaver.

My dad was a blue collar guy. Not given much to emotion, pretty much like his dad and probably his dad before him.

I swear my dad was the role model for Archie Bunker, right down to the easy chair and always wearing white socks.

Dad didn't drink beer, but he did yell a lot. Mostly at my brother and me for what seemed like nothing at all.

It took me years to understand, but in a quirky way, that was his way of showing how much he cared for us.

It all started to come together for me a few years ago when I got a book for Father's day. "Big Russ and Me" was a surprise best seller written by Tim Russert of "Meet the Press" fame.

Tim died on Friday.

I never met the man, and knew nothing about him other than what I read and observed.

Tim was a blue collar guy in a suit and a law degree. He hobnobbed with the Washington elite but never lost his true north.

When I heard that Tim had died, I felt like I had lost a friend. I read both his books and watched him on TV on a regular basis. His enthusiasm and understanding of his craft was contagious. His ability to take (to me at least) a boring topic and make it interesting was true genius.

But the one thing that impressed me most about this guy from Buffalo was his love for his father.

"The person who submitted that question was probably expecting me to name an elusive political figure, or perhaps a fascinating character from history, such as Thomas Jefferson, Christopher Columbus, or my first choice, Jesus Christ. But I took the question personally, and answered it immediately and from my heart: more than anyone else, I would like to interview my dad.

Big Russ has never been much of a talker, especially about himself. Part of it is his modesty: talking about himself probably feels like bragging, which he dislikes in other people and goes out of his way to avoid. It’s not that he’s silent, because Dad is a sociable and friendly guy, and in the right setting, and with people he knows well, you can get him going on any number of topics—politics, baseball, the Buffalo Bills, television, the best kind of hot dogs, and how Canadian beer tastes better when you buy it in Canada. But, like so many men of his generation, he won’t tell you much about his life, his thoughts, or his feelings."

I have to admit, when I read "Big Russ and Me" I actually cried. Much of Tim Russert's life and mine were interchangeable. It made me see my life, and my dad, in a different light.

Apparently others felt the same. So much so that people who read his book sent letters to Tim describing their dad.

This guy from blue collar Buffalo was so overwhelmed by the response, he wrote a second book titled "Wisdom of our Fathers".

I cried when I read that book too.

There is a certain irony that a man who loved his dad (and son) so much would die the weekend of Father's day. Our thoughts and prayers go out to Big Russ who lost his loving son, and to Luke who lost is dad.

Friday, June 13, 2008

Bottom line: I need a catastrophic major medical plan with a $100,000 deductible, no per-claim or annual caps, and at least a $1 million lifetime maximum (more would be better).

Okay, now from the top:

A few days ago, I received a phone call from a gentleman asking about medical insurance. He's an engineer (no, not that kind) with a company of about 2 or 3 thousand employees, all of whom are in the same boat: covered by a generic-looking group medical plan (office visit co-pays, a drug card, deductible and 80/20, etc). Oh, and there's a very generous $5 million lifetime maximum. The catch: a $100,000 annual cap on all expenses. So if there's a big claim, once it hits $100 grand, "you're on your own." This has the gentleman (and his coworkers) understandably nervous. I proposed a cat (catastrophic) plan with a $100,000 deductible. This would basically pick up after/when someone hits their $100 thou annual max. He loved that idea: he had apparently been speaking with other agents, and they were all pushing him to look at $3,500 or $5,000 deductible (HDHP) plans.

So I said I'd look into it, and get back to him. I popped over to an "insurance warehouse" I've used before, because I knew they'd have one. And indeed they had (almost) exactly what I was looking for: their plan had a $100,000 deductible, and a $1 or $2 million cap lifetime max. But there were some internal limitations ($400/day for hospitalization, for example) that were bothersome, and the plan seemed kinda pricey: about $70 a month (he's already paying about $160 per month for the underlying group plan).

Presuming that there were other such plans available, I started Googling, and eventually figured out that there ARE other cat plans out there, but they're all "affinity" (one must be a lawyer, or doctor, or engineer, etc). I did find one very decent plan offered through an engineers' association: good benefits, decent rates, a $50,000 deductible (which would mean some double-coverage, but certainly not a deal-killer).

So I sent him the link to the engineers' plan, explained that he would be better off with this than the one that I could sell him, and maybe I can help him with something else? Well, he called me back, absolutely stunned that I'd push something I wouldn't make anything from, and said "look, I'm not the only guy in this boat. You come up with something like this that YOU can sell me, and I'll put you in front of the other 2 or 3 thousand guys."

Ooookay, you have my attention, sir.

The challenge is finding a carrier to place this with. I have a limited timeframe (I don't want to keep my contact "on hold" any longer than absolutely necessary, for obvious reasons). If you have access to an appropriate plan, please drop me an email, and perhaps we can help this gentleman and his coworkers.

More than once, we've discussed mortality tables, those mysterious numbers on which life insurers base many of their assumptions (and your rates). Well, they've been revised again recently, and the news is encouraging:

Previously, that number was 77.6 years, so this represents a modest improvement. On the other hand, it seems to me that any improvement is a step in the right direction. According to the gummint, this increase is due primarily to "falling mortality rates for nine of the 15 leading causes of death, including heart disease, cancer, accidents and diabetes." Get that? Our health care system is so "broken" that we've actually reduced the number of folks dying from cancer and diabetes (not to mention heart disease).

There's some controversy over the role which lycopene plays in this drama. One study failed to find a correlation between one's level of that substance and the risk of prostate cancer. So it may turn out that there's something else going on with those delicious red (or yellow, or variegated) orbs than the lycopene. Still, something to consider.

No word yet on what role salmonella will play in combatting cancer, though.

Wednesday, June 11, 2008

In Part 1, we learned about new legislation that looks to help reduce the number of uninsured Floridians. Our guest blogger now looks at the potential downside, and offers some food for thought:

■ The bad

Along with the good provisions of this policy, there are also some challenges. There are challenges for those interested in purchasing the policies, the carriers offering the policies, and the State of Florida.

The biggest issue I see with this offering is the potential for under-insuring. Health care is very complicated and it takes some investment by the individual to become an informed consumer. There is potential for someone who chases the lowest premium to wind up in much the same position they would be in if they were uninsured. This also applies to those that don’t understand pre-existing exclusions, and pursue a course of treatment during their exclusionary period.

While many mandates are based on rare, elective or unproven treatments; others are based on inadequacies of current offerings. Things such as certain transplant benefits, cancer drugs and postnatal care. By removing all mandates, there is further potential for a subscriber to realize a catastrophic loss.

Questions remain as to what the offerings will look like to hit the $150 price point. Carriers that improperly estimate their actuarial exposure could take a loss that would affect their ability to offer competitive products to their other segments. Carriers could also realize a loss based on the fact that many first time insureds or those coming off a period of being uninsured tend to over utilize the first couple of years. This could start the product out with either a bad risk profile or a loss during those first years. There is also the risk associated with brand perception if the under-insuring item does become an issue.

The State of Florida has taken an aggressive action to address the health care concerns in today’s market. There is potential for significant political ramifications if they cannot deliver on this initiative. They have made many promises in this legislation that they will have to rely on outside partners to fulfill. They also walk the line of alienating brokers with the advent of the Florida Health Choices Corporation. The success or failure of this program has already become a point of discussion in the upcoming presidential election. There are many in the universal coverage camp with a vested interest in the failure of this initiative.

■ The unanswered

With any new program, there are always many questions. This initiative is no exception. The basic rules have been laid out, a framework has been envisioned, now we have to look to the market and see what types of offerings will be available. We must also look to the role of the brokerage community in marketing these plans. The final piece that has not been addressed is the medical providers.

Will there be multiple carriers allowed to offer plans within the guidelines ala Medicare Choice? Or will there be a bid process to control and manage the block like some of the state risk pools? It may also be possible to set up a separate subsidy program similar to the “three share” programs being proposed in Texas. Can the benefits hit the price point? Is that price point firm? What are the obligations of the carrier as far as assessing the risk offsets and renewals? Will there be a risk based scale or a COLA adjustment or a combination of the two? Can there be HSA options?

There are also questions from the broker community. Will the state actions push some producers out of the individual market and 2-50 market by establishing direct marketing entities and operating as the broker between proposed plans and the insured? What is the exact role of the Florida Health Choices Corporation? Can the agents help to market these plans and receive compensation?

The question that has only been touched on in the statistics is the medical community. There are provisions to enhance the role of community health providers in the outreach to the uninsured. This is to keep uninsured out of the ER and into community health clinics. The question that comes up is: If they are not paying currently and going to the ER, what is the driver that would encourage them to pay premiums and use the lower cost clinics?

The last question and one that I have yet to see addressed in any commentary or policy paper: Since Health Flex plans were a bust, has Florida learned from their previous mistake?

There is a lot to consider, but it is nice to see a market based solution being proposed. Now it is the market’s turn to see if they can rise to the challenge.

Thank You! We truly appreciate all the effort that went into these posts, and we'll keep our readers updated on how the program fares.

Seems that Ms Tejada was actually recruited to come to Canada as part of Canada's "federal live-in caregiver program." This is a deal where foreign nationals agree to come live and work in Canada, providing daycare for Junior Canucks. As long as they complete the three year program (and pass some background checks), they're fast-tracked to permanent resident status.

Unless, of course, they get sick. Then the Canadian health system is not so much "compassionate" as "stingy." This is pretty ironic, considering how much money we Americans are willing to spend on illegal immigrants. But our system is somehow "inferior" to theirs?!

Several months ago I blogged on a new test to determine the likelihood that one may be more or less susceptible to having Alzheimer's. At the time, I questioned the usefulness of the test, and asked whether one was better off knowing the results.

The issue there was about personal choice and priority. After all, since we don't know what causes Alzheimer's, there's really nothing one can do (at this point) to either increase or decrease that likelihood. Perhaps I should have asked whether or not we should be requiring our parents to take that test, to see if we in the sandwich generation will face an added burden.

Dr John Crippen, doc-blogging [ed: you just made that up!] as the NHS Blog Doctor, presents a delightfully whimsical, overtly off-the-wall, totally readable Grand Rounds. It's fun, too, since there's so much to choose from.

I was particularly intrigued by our friend David William's post on Singapore's health care system, which seeks to bridge the gap between public and private sector efforts. Highly recommended.

Monday, June 09, 2008

Regular readers may recall our piece on group insurance audits, wherein employers are required to verify that the folks on the plan are supposed to be, and that everyone that's supposed to be on the plan is [ed: clear as mud]. Early last week, one of my groups received such a request from its carrier, United Healthcare (UHC). They called me, and I helped them fill out the form. Once it was completed, they faxed it to me and I forwarded it on to our service rep. Total time involved: maybe 15 minutes, tops.

Later in the week, I received an email from the service rep: UHC wanted to know what the form was for, and why we'd sent it. Here is my response, copied directly from the "Sent" folder:

UHC sent this form to my client, who then complied by actually, um, completing and submitting the form as requested by the idiots/morons at UHC home office.

That help?"

My rep assured me that he'd take care of it (and I knew that he would: Don is exceptionally good at this, and really does make my job easier). He also said he'd delete my unsolicited review of UHC personnel (darn!). Well, at least I could put it away and move on.

Sure! This morning, I received a copy of a letter that UHC has sent my client, which starts with "Advanced Notification of Contract Cancellation Due To No Response And/Or Incomplete."

Let me get this straight: we get the form, we complete the form, we return the completed form, we're asked WHY we sent the completed form, and now we're facing cancellation because we didn't return the completed form?

So I called Don, and brought him up to speed. He asked me to email the letter and he'd get this resolved. So I did (and what did I title the pdf file? This: [client]_uhc_morons.pdf).

But you said tricks, Henry. Is there more?

Oh, indeed yes, dear reader:

Sometime around the last week of May, the owner of another of my groups called to tell me he would be turning 65 in June, and needed some advice. His spouse has some health issues, and we really need to keep her on the group, which we have with Anthem. He's continuing to work, so that's not a big problem. I explained to him that, since it's under 20 employees, Medicare is primary and so the group essentially becomes a Medicare Supplement plan.

"That's nice, Henry," he said, "but what's it gonna cost me?" Well, let's look at the renewal, which should have the MedSup rates in it.

Except it doesn't. So I request these rates. Three times in the past two and a half weeks. And until just a few minutes ago, I couldn't get them. The penultimate email read:

"I sincerely apologize for the delay in getting the Medicare rates to you. Enrollment/Billing was not able to pull them for me so I have to go back to underwriting to see if they can provide. I am hoping for a response from the underwriter today. I will let you know as soon as I get something back from her."

I received that about an hour ago, and replied:

"I guess it's comforting to know that UHC isn't the only company run by incomptent morons and idiots. Just not VERY comforting."

Five minutes ago (while I was composing this post), I received this wonderful news:

"The member that is turning 65 would pay the same rate as the active members. The renewal rates are based on the current census and since this member was not on Medicare at the time of the renewal, the Medicare rates will not apply until their next renewal."

Ever prescient, we actually blogged on this subject over two and a half years ago.

The Society for Human Resource Management reports that many employers are choosing to offer increased benefits, rather than pay raises, to offset some of these costs. These range from increasing the gas allowance to performance bonuses in the form of pre-paid gas cards. Some employers are even encouraging (and helping) employees to form car pools.

While online quote engines like eHealth have enjoyed success, it's another thing entirely for a carrier to make a go of selling directly to the consumer. There are a number of reasons for this:

■ Lack of market penetration. Most people still prefer to deal directly with agents, and it's the agent that can "talk up" a particular carrier. Without this direct contact, companies (especially lesser-known ones like AC) can find it difficult to break into the market.

■ Lack of value. Consumers pay the same rate whether buying direct or through an agent. Since there's no financial incentive to avoiding "the middle man," consumers have no real reason to do so.

■ Lack of choice. When dealing directly with the carrier, the consumer is told only that carrier's "story," and given no information about other choices. This is especially problemmatic for consumers with health issues: if AC (for example) can't help them, they have no idea what options may be available in the open market.

■ Lack of relationship. An agent isn't just a salesperson, but an advocate. If (when) there's a claims problem, for example, an independent agent (who works for the client) can help navigate the home office, and is one more voice on the client's behalf. Dealing directly with the carrier means that, should there be a problem, there's no such outside advocate to help out.

There is a growing unrest in the nation, and a call to eliminate poverty that is caused by a lack of universal access to health care. The movement to correct this imbalance calls for universal health insurance mandates that protect workers against lost wages as well as the cost of health care.

The Socialist Party has long supported compulsory coverage and has encouraged presidential candidates to include this stance in their platform.

Various women's groups are also in support of the movement, particularly as it pertains to benefits that cover women's health issues.

Labor leaders have denounced the government intrusion and are supportive of requiring employers to provide insurance programs. The labor movement was in favor of making health insurance mandatory for low wage workers

The legislation seemed "advantageous for workers and doctors" because workers could "return to their jobs more quickly" with improved access to health care and physicians would "prosper if a growing number of patients could pay their fees," Crossen writes. However, she writes that private health insurers, fraternal organizations, pharmacists, manufacturers, labor unions, Christian Scientists, anti-Communists and physicians partnered to defeat the legislation for "wildly different motives."

Some labor unions maintained that the legislation would "lead to the determination of who was a good insurance risk," and some private health insurers criticized the legislation as "un-American," according to Crossen. In addition, many physicians maintained that the legislation "would insert the dubious judgment of the government between patient and doctor and cut their pay," Crossen writes. She writes, "In the end, not a single state passed a health insurance law"

As the debate continues more vocal groups shift the focus away from replacing lost wages and instead, are promoting ways to keep medical treatment affordable.

At least one presidential candidate has embraced the idea of change in the health care delivery system and has made that part of his campaign.

That candidate is Teddy Roosevelt, the Bull Moose candidate in the 1912 election.

From time to time, we present guest posts written by our readers. Recently, a long-time reader tipped us to new legislation in the Sunshine State; its goal is to help decrease the rolls of the uninsured. Since the reader in question is someone with whom we've corresponded for a while, and indeed has helped us in other efforts, we've invited our (herein) anonymous friend to dissect the Cover Florida Health Care Access Program:

■ What is it?

SB2534 was the driving legislation behind this program. The state of Florida has taken on the lofty goal of addressing the issue of the uninsured with a market driven approach. Under this plan, carriers would be allowed to bid on plans to be offered to the individual market. These plans are designed to cater to the uninsured.

There are two types of plans, a catastrophic and a non-catastrophic. Catastrophic would be based on hospital services, urgent care, outpatient surgery. Non-catastrophic would focus on wellness and preventative care, including office visits and office based surgery. These can be offered separately or in combination based on the bid from the carrier, but must include a prescription benefit. These plans are required to be guaranteed issue, but can have pre-existing limitations. The state is looking for them to hit a $150/mo price point.

In order to be eligible to participate, the potential enrollees must be below age 65, have family income below 300% of poverty level, and have been uninsured for at least 6 months. They cannot be eligible for other public health insurance programs. Exceptions are if they lost coverage due to loss of job with health benefits, expiration of COBRA, reaching a limiting age, or loss of benefits due to death or divorce of spouse.

Other provisions establish the Florida Healthy Kids Corporation to administer the Florida Kid Care Program. It removes the 10% cap for families paying the full premium for the Florida Kid Care Program. It adjusts the age of eligible dependents from 25 to 30. House additions include the establishment of the Florida Health Choices Corporation that acts as a clearinghouse for employees of small businesses (under 50) to purchase an array of benefits.

This is what I have gathered by reviewing the text of the bill as well as the official press releases. It's all subject to change based on any further action by the State of Florida or their Department of Insurance.

■ The good

As I see it, the biggest boogeyman of those pushing for universal health care is the issue of the uninsured. We hear the statistic in every argument and news report on the subject. We have disassembled the numbers, but a sound bite often has longer legs then an in depth analysis and is easier to repeat. So let’s go into the good things about this initiative.

It attempts to hit an affordable price point by exempting offerings from state mandated benefits. Often these mandates are placed into effect not by consumer complaints or needs, but by lobbying efforts of an advocacy group or providers of the mandated services. There are often mandates for questionable homeopathic services like acupuncture, and high dollar elective procedures like fertility treatment. These mandates can greatly increase the costs of a policy and put unnecessary claims dollars into the risk pool.

The increase in dependent age to 30 will help cover the young invincible segment. This helps to address those in the 19-30 segment that choose to go without coverage for a variety of reasons. This is the largest segment of the uninsured. Also by bringing those low utilizers into the risk pool, it helps balance the overall risk profile of the employer based segment.

By removing the cap on full pay enrollment in KidCare, it allows parents another option for insuring their kids. The key here is that these parents are paying the full premium cost of the program and creating an economy of scale in the program that would allow it to become less dependent on government subsidies.

Guarantee issue policies also address the next big issue for universal advocates, the uninsurable. With the guarantee issue provision in this initiative, anyone who fits the market and wants to purchase the coverage can do so. With pre-existing condition limitations allowed, it also allows the carrier to offset some of the excessive risk associated with guarantee issue products.

The last point I will mention in the good category: no Massachusetts-style individual mandate.

Whew! That's a lot to digest, and we're only beginning. In Part 2, our guest blogger has the other side of the coin, as well as some thought-provoking questions.